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Background Preoperative education has been found to be responsible for patients having a realistic expectation of surgery as well as high level of satisfaction with their recovery. The Joint Academy offers preoperative educational classes for all patients undergoing elective knee and hip replacements. Purpose The purpose of this descriptive study was to determine whether the education provided by The Joint Academy has an impact on anxiety, expectation, and preparedness in patients who undergo elective total knee or hip arthroplasty. Methods All patients who had total joint or hip arthroplasty over a 2-month period were invited to participate in this descriptive correlational study. Results Of the 49 study participants, 28 attended The Joint Academy. Those who attended The Joint Academy were more likely to hold surgical expectations that better correlated with actual experience (p = .425). There was no statistically significant difference between the groups for nervousness (p = .171) or feeling prepared for the surgery (p = .425). Conclusion Offering education before knee or hip arthroplasty provides patients with an understanding of the expectations related to surgery.

Background In nursing care homes (NCHs), the use of end-of-life care (EoLC) medication has traditionally been requested and prescribed on an individual basis during each resident’s last days of life. However, some GPs are reluctant to prescribe EoLC medication in anticipation of symptoms occurring if, at the time of their visit, the resident is symptom-free. Even when prescribed, care home staff can experience difficulties obtaining the medication out of hours. This can result in residents not having access to appropriate medications when they are experiencing symptoms. Aim This audit aimed to assess the feasibility of NCHs with Gold Standards Framework in Care Homes (GSFCH) accreditation keeping EoLC medications ‘as stock’, rather than having the medication prescribed and dispensed for individual residents when residents became symptomatic. Methods Meetings were held with nurse managers of four NCHs with GSFCH accreditation, local pharmacists and the hospice pharmacist. A strategy to implement the stock medication was prepared. A baseline review of the notes of deceased residents 6 months pre-implementation was undertaken and information regarding symptoms and EoLC medication extracted. The review continued for 6 months after the stock EoLC medication was obtained. Results Three NCHs participated. The notes of 92 deceased residents were examined. Fifty-three per cent of decedents were found to have experienced common EoLC symptoms. The numbers with access to EoLC medication increased once the stock medication was in place. However, some residents still had their own drugs dispensed, despite stock drugs being available. Conclusions There is a need for all dying residents to have access to EoLC medication. The proper facilitation and implementation of EoLC medication ‘as stock’ into NCHs with expertise in caring for dying people could save monies at a time of NHS austerity measures. If the NCHs had relied solely on the stock medication, the reduction in medication waste would have been significant. The introduction of stock medication would also solve problems associated with obtaining medication out of hours. Conflicts of interest: none

As society moves into the second decade of the 21st century, information and communication technologies have established themselves firmly in daily life for most individuals with means and access t...

To estimate the incidence and severity of bone loss in menopausal women diagnosed with cancer who receive treatment with chemotherapy. Also, to evaluate the use of bone loss prevention agents in this population.A total of 25 postmenopausal women with newly diagnosed cancers who received chemotherapy for a minimum of six cycles were enrolled in this pilot study. All subjects underwent baseline bone mineral density (BMD) testing of the lumber spine (LS), left hip (LH), and femoral neck (FN). Of the 25 women, 22 also underwent follow-up BMD testing at 6 months.The median age of the subjects was 61 years (range 41-76 years) and the median age of menopause was 50 years (range 34-55 years). Of the 25 subjects, 9 used at least 1 g oral calcium daily, 4 used alendronate, 2 used raloxifene, and 1 used oral estrogen. The mean BMDs (g/cm2) with standard deviation above or below the mean for young adult women at baseline were: LS 0.996 (-0.5 SD), LH 0.876 (-0.5 SD), and FN 0.760 (-0.7 SD). The following values were obtained at 6 months: LS 0.965 (P0.001), LH 0.847 (P0.001), and FN 0.739 (P=0.009).Menopausal women diagnosed with cancer appear to have a high incidence of baseline bone loss, with significant additional loss during treatment. Use of agents for prevention/treatment of bone loss in this group is infrequent. A prospective, controlled analysis is indicated to determine the optimal utility of bone densitometry testing and osteoporosis prevention strategies in this population.

The Care Certificate launched by Health Education England (HEE) this year comprises a set of 15 standards to address the inconsistencies of induction training for new staff entering the health or care profession (Cavendish Review 2013). From April 2015 all new support staff working in health or social care must demonstrate the essential standards within the Care Certificate as part of their overall induction and all existing staff must be appraised against the Care Certificate standards. Learning from participation in the national pilot led to St Christopher’s successfully applying to City and Guilds for accreditation for the ‘Care Certificate (Cavendish) from St Christopher’s’. The 15 standards are taught and assessed holistically with learning contextualised for the setting in which care is being delivered, for example, for local care home staff the needs of patients with dementia, long term conditions, care of the frail elderly and those approaching the end of life are incorporated. With funding from the Local Education and Training Board (LETB), Health Education South London (HESL) this ‘hospice’ version of the Care Certificate has now been rolled out by the South London Hospice Education Collaborative to 12 local care homes. This is not only about training care home staff to deliver good fundamental care but about empowering care homes to become more effective learning environments. The project has included funding to train a nominated senior member of staff from each care home as a fully qualified assessor achieving the Level 3 QCF Certificate in Assessing Vocational Achievement (CAVA). This will facilitate care homes to be part of the delivery of vocational qualifications for their own staff ensuring future training and educational needs are addressed through a recognised accredited route.

Background The National End of Life Care Strategy (DoH) highlighted in 2008 the need to develop the workforce, including the non-registered workforce. Health Care providers also report challenges around the recruitment of Registered Nurses. The lack of career development for Health Care Assistants (HCAs) equally comes withits challenges going forward. The South London Hospice Education Collaborative (SLHEC) decided to work with Croydon College to develop a programme to deliver the City and Guilds Level 5 Diploma for Assistant Practitioners in healthcare. This a vocational higher apprenticeship programme for HCAs to prepare them for a Band 4 (Afc) post. The programme is delivered by hospice clinicians and Croydon College and funded by Health Education South London and the Skills Funding Agency. Aims Deliver a bespoke educational programme Evaluate the educational programme and its impact on patient care Offer higher apprenticeship education Collaboration between eight hospice, one care home and Croydon College Delivery Employers selected learners for this course through a process of application, interview and literacy/numeracy tests. The course started in March 2015 with 20 learners from adult and children9s Hospices and one Care Home. Challenges Ensuring that Band 4 (Afc) fits in with future workforce development/strategy at the individual Hospices and Care Home. Supporting learners, assessors and teachers across a number of organisations. Delivery of vocational programme by hospice staff in further education. Evaluation Two Units completed and well evaluated by learners. The impact on patient care and workforce development will be evaluated as part of a Master9s degree. Plans Ensure sustainability Share learning with hospices and stakeholders Approach professional bodies/stakeholders to share to discuss recognition and registration of Assistant Practitioners

Objective To determine the long-term outcome of pregnancies prenatally diagnosed with trisomy 16 and identify variables associated with the outcome. Methods We reviewed all published and our unpublished data from trisomy 16 pregnancies for which outcomes were available for children of greater than 1 year of age. Results Nineteen cases were diagnosed with trisomy 16 on chorionic villus sampling (CVS) and 17 cases at amniocentesis. Age at last follow-up ranges from 1 to13 years. Among the CVS group, four out of five patients, with a birth weight and/or length below −2 SD and postnatal growth information, showed catch-up growth (80%). Among the amniotic fluid (AF) group, the birth weight was available in 13 cases. Eleven of the 13 cases had a birth weight less than −2 SD. In eight cases, the length was also below −2 SD (length data unavailable in one case). Nine out of ten cases (90%) and seven out of eight (87.5%) showed catch-up growth for weight and length, respectively. In terms of development, no cases of CVS mosaicism had global developmental delay. One child had a history of delay in speech development. Among the AF-detected cases, 4/17 cases had global developmental delay. All four children with global developmental delay had more than one major malformation compared to 6 out of 32 children in the group with normal development (p = 0.004). The finding of uniparental disomy (UPD) was not associated with developmental delay. Conclusions The majority of prenatally diagnosed trisomy 16 mosaic cases have a good postnatal outcome. However, the finding of mosaicism on AF and the presence of major congenital anomalies are associated with an increased risk of developmental delay. Copyright © 2006 John Wiley & Sons, Ltd.

This article summarizes current second trimester prenatal screening methods, and describes recently developed first trimester screening tools. The advantages and potential pitfalls of first trimester screening are outlined.

to determine if there were sex differences in patients' use of hospice services in a regional cancer center in Texas from 1998 to 2000.A quality-of-life program for patients with cancer that included an end-of-life component was initiated in 1998 at a regional cancer center. The records of 1057 female and 986 male cancer patients who died from 1998 to 2000 were reviewed. Data on demographics, use of hospice care, length of stay, and location at time of referral were collected and analyzed.Hospice utilization increased in women (47% v 64%; p.001) and men (53% v 66%; p.001) who died of cancer from 1998 to 2000. Length of stay (LOS) in hospice did not change for women, but decreased significantly for men over that time (31 days v 14 days, p.001). The number of men with stays of 14 days or less increased significantly (30% v 53%, p.001). Subjects whose LOS were less than 14 days were more likely to be hospital inpatients at time of referral.The institution of a targeted end-of-life program was associated with increased utilization of hospice services in women with cancer at this regional cancer center. Length of stay in hospice was longer for women than men, and more men had very short (less than 14 day) stays. Hospice referrals from outpatient settings were associated with longer LOS.

Five french (5F) catheters are being widely promoted for use in patients undergoing day case angiography including coronary angiography. Although there are theoretical advantages to this practice there are also potential disadvantages. We reviewed various performance parameters of four different brands of 5F coronary catheter and compared them with performance of the six (6F) and eight french (8F) coronary catheters used in routine coronary angiography. All the 5F catheters performed significantly less satisfactorily than the 6F and 8F catheters. 5F coronary catheters cannot be recommended for routine transfemoral coronary angiography.

The Gold Standards Framework for Care Homes [GSFCH] and the Liverpool Care Pathway [LCP] guidance suggests the importance of obtaining anticipatory medication for the control of symptoms in the last days of life for nursing home (NH) residents. There is considerable wastage however as NH residents are dispensed anticipatory drugs on a named-patient basis. There is also evidence that when these drugs are not available residents are hospitalised inappropriately. Aim The aims of the project were to explore the frequency of symptoms experienced in the dying phase and to explore whether there was a need for residents to have their own supply of drugs by examining wastage. The idea was to establish a process in order for homes to obtain anticipatory medication as ‘stock’ and to capture the benefits of doing this. Process The managers of three NHs, who had shown interest in obtaining medication for the last days of life, met with a local GSFCH facilitator, specialist palliative care pharmacist and a pharmacist from the regulatory body. A proposal that included a list of necessary medication and how to acquire them was written. The NH staff developed the required Standard Operating Procedures. A prospective audit on medication used was commenced. Results Significant improvements in the availability of anticipatory medication were found. 53% of residents were symptomatic highlighting the need to have anticipatory medication available. No medication other than “stock” was required by NHs. If all residents had their own supply of medication £4,506 worth of drugs would have been wasted. All staff involved perceived that this work had been beneficial. Conclusion Anticipatory medication ‘as stock’ for people dying in NHs is an important step forward. There is less wastage of medication, less delay in controlling symptoms, reduced call out of GPs and less anxiety.